Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH REFRRD ANTIBODY ID-COMPLX

Facility

$1,594.00

Service Code	HCPCS 86870
Hospital Charge Code	397031131
Hospital Revenue Code	300
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$1,537.15
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,537.15
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$478.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$42.24

CH RENAL FUNCTION PANEL

Facility

$183.00

Service Code	HCPCS 80069
Hospital Charge Code	397073342
Hospital Revenue Code	301
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.61
Rate for Payer: Aetna Medicare Advantage	$28.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.33
Rate for Payer: Cigna Commercial	$91.50
Rate for Payer: Cigna Medicare Advantage	$8.68
Rate for Payer: Clover Medicare Advantage	$8.25
Rate for Payer: EmblemHealth Commercial	$26.04
Rate for Payer: Humana Medicare Advantage	$8.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.68
Rate for Payer: Wellcare Medicare Advantage	$8.68
Rate for Payer: Wellpoint Medicaid Managed Care	$4.85

CH RENAL FUNCTION PANEL

Facility

$183.00

Service Code	HCPCS 80069
Hospital Charge Code	397073342
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

CH RENIN

Facility

$204.00

Service Code	HCPCS 84244
Hospital Charge Code	397072015
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$59.81
Rate for Payer: Aetna Medicare Advantage	$71.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.38
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: Cigna Medicare Advantage	$21.99
Rate for Payer: Clover Medicare Advantage	$20.89
Rate for Payer: EmblemHealth Commercial	$65.97
Rate for Payer: Humana Medicare Advantage	$22.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.99
Rate for Payer: Wellcare Medicare Advantage	$21.99
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

CH RENIN

Facility

$204.00

Service Code	HCPCS 84244
Hospital Charge Code	397072015
Hospital Revenue Code	301
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

CH RETICULOCYTE COUNT

Facility

$59.00

Hospital Charge Code	397021018
Hospital Revenue Code	305
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

CH RETICULOCYTE COUNT

Facility

$59.00

Hospital Charge Code	397021018
Hospital Revenue Code	305
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

CH REVERSE TRANSCRIPTION

Facility

$67.00

Service Code	HCPCS 83902
Hospital Charge Code	397073299
Hospital Revenue Code	301
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

CH REVERSE TRANSCRIPTION

Facility

$67.00

Service Code	HCPCS 83902
Hospital Charge Code	397073292
Hospital Revenue Code	301
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

CH REVERSE TRANSCRIPTION

Facility

$67.00

Service Code	HCPCS 83902
Hospital Charge Code	397073292
Hospital Revenue Code	301
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

CH REVERSE TRANSCRIPTION

Facility

$67.00

Service Code	HCPCS 83902
Hospital Charge Code	397073299
Hospital Revenue Code	301
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

CH RHOGAM

Facility

$139.25

Service Code	HCPCS J2792
Hospital Charge Code	397031022
Hospital Revenue Code	636
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$123.67
Rate for Payer: Aetna Commercial	$93.19
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.67
Rate for Payer: Cigna Medicare Advantage	$34.26
Rate for Payer: Clover Medicare Advantage	$32.55
Rate for Payer: EmblemHealth Commercial	$102.78
Rate for Payer: Humana Medicare Advantage	$35.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.26
Rate for Payer: Wellcare Medicare Advantage	$34.26
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

CH RHOGAM

Facility

$139.25

Service Code	HCPCS J2792
Hospital Charge Code	397031022
Hospital Revenue Code	636
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$33.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

CH RIFAMPIN (SERUM) HPLC

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	397073660
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH RIFAMPIN (SERUM) HPLC

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	397073660
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH RISPERAL

Facility

$378.00

Service Code	HCPCS 80299
Hospital Charge Code	397073198
Hospital Revenue Code	301
Min. Negotiated Rate	$10.02
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$189.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.02

CH RISPERAL

Facility

$378.00

Service Code	HCPCS 80299
Hospital Charge Code	397073198
Hospital Revenue Code	301
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$56.70
Rate for Payer: Qualcare PPO/HMO/WC	$56.70

CH RISPERDONE

Facility

$268.00

Service Code	HCPCS 80299
Hospital Charge Code	397071363
Hospital Revenue Code	301
Min. Negotiated Rate	$40.20
Max. Negotiated Rate	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$40.20

CH RISPERDONE

Facility

$268.00

Service Code	HCPCS 80299
Hospital Charge Code	397071363
Hospital Revenue Code	301
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$134.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$134.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

CH RISTOCETIN CO-FACTOR

Facility

$152.00

Service Code	HCPCS 85245
Hospital Charge Code	397073078
Hospital Revenue Code	305
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

CH RISTOCETIN CO-FACTOR

Facility

$152.00

Service Code	HCPCS 85245
Hospital Charge Code	397073078
Hospital Revenue Code	305
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

CH RISTOCETIN COFACTOR

Facility

$142.00

Service Code	HCPCS 85245
Hospital Charge Code	397073317
Hospital Revenue Code	305
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

CH RISTOCETIN COFACTOR

Facility

$142.00

Service Code	HCPCS 85245
Hospital Charge Code	397073317
Hospital Revenue Code	305
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

CH RISTOCETIN COFACTOR VWF

Facility

$225.00

Service Code	HCPCS 85245
Hospital Charge Code	397072123
Hospital Revenue Code	305
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CH RISTOCETIN COFACTOR VWF

Facility

$225.00

Service Code	HCPCS 85245
Hospital Charge Code	397072123
Hospital Revenue Code	305
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

Know your out-of-pocket cost for care.

All Charges